UNDERGRADUATE NURSING MANDATORIES INFORMATION FIRST YEAR MANDATORIES DUE No Mandatories Due SECOND YEAR MANDATORIES DUE No Mandatories Due THIRD YEAR MANDATORIES DUE JUNE 1, 2018 Pre Clinical Mandatories Form If you have a history of a positive PPD, use the TB Symptom Checklist which can be obtained from Christina Adamczak (Christina.Adamczak@med.uvm.edu) HIPAA/OSHA Training You will complete your training through the Evolve e Learning Solutions website. You will receive an email with your username and password to log in and a link to the Evolve e Learning HIPAA/OSHA courses. CPR Certification CNHS only accepts certification through the American Heart Association Basic Life Support for Health Care Providers OR American Red Cross Professional Rescuer. You will receive email notification about upcoming CPR training offered by CNHS. Third Year Students Submit Mandatories forms and required attachments (copy of CPR card with signature and copy of health insurance card) to CastleBranch. FOURTH YEAR MANDATORIES DUE JUNE 1, 2018 Annual PPD Form. If you have a history of a positive PPD, use the TB Symptom Checklist which can be obtained from Christina Adamczak (Christina.Adamczak@med.uvm.edu) HIPAA/OSHA Training Required Annually. Log in to the Evolve e Learning Solutions website to complete your training. CPR Certification Ensure that your CPR certification will remain valid throughout your clinical experience this year. CPR Certifications are valid for two years. If you completed the training during your third year, it should still be valid. Annual Influenza vaccine due in October. Fourth Year Students Submit your Mandatories forms and required attachments (copy of CPR card with signature and copy of health insurance card) to CastleBranch.
The University of Vermont Memorandum TO: Health Care Provider FROM: Clinical Education Staff DATE: March, 2018 SUBJECT: College of Nursing and Health Sciences Health Clearance Requirements You are receiving the attached University of Vermont immunization record form because your patient is participating in clinical education as part of the curriculum within one of the College of Nursing and Health Sciences (CNHS) academic programs. CNHS follows CDC recommendations for health care professionals. Although from a professional standpoint, you may feel that your patient doesn t need some of these requirements, from a health profession standpoint, it is required. Please take the following action: Complete the attached form in its entirety. As the licensed health care provider, please make sure to sign and date the bottom of the immunization form. Students must submit their requirements on the school form. Lists of immunizations or lab reports are not accepted, except for a radiology report if it is the student s first time with a positive PPD. If there is no record of 2 doses of the Varicella vaccine, please test for immunity to Varicella with a titer. Due to the history of Varicella sometimes not being accurate, our approach is to check with a titer if there is no documentation of two doses of the vaccine. Those whose titer is negative should receive 2 doses of the Varicella vaccine and need not have further immunity testing. CNHS students are required to complete a series of 3 Hepatitis B vaccinations, followed by a positive titer. If the titer is negative or indeterminate, please repeat the full series of 3 doses, followed by another titer. A booster is not acceptable and the series must be repeated. UVM follows the CDC guidelines of doses at 0, 1 and 4 months from the first dose and a titer 1 to 2 months following the third dose. Should the second titer not demonstrate immunity, the student is considered a non-responder and should be informed accordingly of their risks for working in the health care field. For Hepatitis B titers and PPD results, please circle the result. If you have any questions/concerns, please contact Christina Adamczak at: (802) 656-2018 or Christina.Adamczak@med.uvm.edu Thank you for your assistance in this process. COLLEGE OF NURSING AND HEALTH SCIENCES 106Rowell Building,106 Carrigan Drive, Burlington, VT 05405 0068 (802) 656 0958 fax: (802) 656 2191 Equal Opportunity/Affirmative Action Employer
PRNU 3 rd Year Requirements REQUIREMENT: GUIDELINES: DUE DATE EXP. DATE MEASLES MUMPS RUBELLA TETANUS, DIPTHERIA and PERTUSSIS HEPATITIS B Provide proof of one of the following completed on school form: A) 2 doses of Measles, Mumps and Rubella (MMR) OR OR C) positive antibody titers for all 3 components. Tdap within the last ten years. Both of the following are required on school form: 3 vaccinations (either alone or combined with Hepatitis A vaccination) AND a positive antibody titer. Timeline for doses: Receive 1 st dose, Receive 2 nd dose 1 month later, Receive 3 rd dose 4 months from 1 st dose; Receive titer 1 to 2 months after 3 rd dose. No expiration 10 years after date that Tdap was given If positive, no expiration DOCUMENT REQUIRED: form form form ADDITIONAL INFORMATION: Upload form to CastleBranch If you have not had a Tdap and your last Td is more than two years old, you are required to have a Tdap. If your Tdap is more than 10 years old, a booster is not acceptable, another Tdap is required. If titer is negative or indeterminate, you must repeat 3-dose series and titer. A booster is not acceptable. Submit each dose and final titer after it is completed to CastleBranch on the Hepatitis B Second Series Form. Use the same form each time you submit each dose and titer. VARICELLA One of the following is required: A) date of disease AND positive antibody titer OR B) 2 vaccinations for varicella. If positive, no expiration form Titer required with history of disease. No titer is required with documentation of two doses of vaccine. TB SKIN TEST TB Skin Test OR QuantiFERON Gold test is required annually. Annual requirement form If positive results, one of the following is required: Student with a first time positive PPD must submit the school form AND a copy of the radiology report. Student with a history of positive PPD, must submit the school form AND the TB Symptom Checklist form. INFLUENZA VACCINATION Influenza vaccination for current flu season After 10/31/2018 And 11/20/2018 Valid for current flu season form or health care provider s form Upload to CastleBranch CPR One of the following is required: A) American Heart Association Basic Life Support for Health Care Providers OR B)American Red Cross Professional Rescuer Certification must remain valid for entire clinical experience Copy of front and back of CPR certification card Certification must remain valid for entire clinical experience. Certification is valid for two years after date on card PROOF OF HEALTH INSURANCE Provide a copy of your current health insurance card AND Proof of Health Insurance form. If your insurance changes, you are responsible for providing updated information Copy of insurance card or equivalent AND Proof of Health Insurance form This is an annual requirement. HIPAA/OSHA TRAINING Complete your HIPAA/OSHA training via the Evolve e-learning Solutions website at: https://www.evolvelms.com/lms/uv m/default.aspx OSHA training includes Bloodborne Pathogens course. Annual requirement No need to submit a document as long as you ve completed your online training. Training won t be considered complete unless all sections of the training have been completed.
PRNU 3 rd Year Requirements Notes from CNHS Christina Adamczak Please note, some site placements may require additional mandatories such as a physical, criminal background check, or drug screen. If you visit UVM s Center for Health and Wellbeing for your immunization/serology work, you can request a receipt and file it along with the claim to your insurance company. Please be sure to fill out the top of each form with your identifying information before submitting it to CastleBranch. It is your responsibility to keep track of whether you have submitted your requirements and to pay attention to deadlines for renewals. If you know you will be unable to meet the above deadlines for extenuating circumstances, you should schedule a meeting with Christina Adamczak at Christina.Adamczak@med.uvm.edu
COLLEGE OF NURSING & HEALTH SCIENCES Name: Date of Birth: Program / Graduation Year: Date: CNHS INSURANCE REQUIREMENTS Proof of Health Insurance Form- Submit this form AND copy of insurance card *The University does not pay medical costs resulting from injury during clinical/practicum rotations or other curricular activity unless this injury is due to negligence of the University. All CNHS students are required to carry their own health insurance. It is your responsibility to resubmit your insurance if there are any changes. Subscriber/Member ID Insurance Carrier Primary Subscriber's Name Subscriber's Relationship to You It is MANDATORY that you scan and upload this form AND a copy of your insurance card to CastleBranch. The information included on this form maybe released to the infection control officer and clinical education coordinators at sites where you perform your clinical education experience.
PRE-CLINICAL MANDATORIES College of Nursing and Health Sciences Program: To be completed by a licensed health care provider. Copies of medical records/labs will not be accepted. Student Name: Date of Birth: / / Cell phone#: ( ) - Last Name First Name Middle Initial Part 1: Everything must be filled out by your licensed health care provider on this UVM form ONLY. Copies of Medical Records/Labs will NOT be accepted. VACCINE NAME DATES OF VACCINATION OR DATES OF POSITIVE TITERS (BLOOD TEST) OR DISEASE HISTORY TDAP Not applicable Tdap in last 10 yrs. If you Tdap Date: / / have not had a Tdap and your last Td is more than two yrs. a Tdap is required. (Do not receive a Td booster.) HEPATITIS B Dose at 0, 1 and 4 mos from 1st dose #1: / / #2: / / #3: / / Surface AntibodyTiter (Circle One:) Titer 1-2 months after 3rd dose Positive or Negative (titer required with 3 doses) Date: / / REPEAT HEPATITIS B *Dose at 0, 1 and 4 mos from 1st dose #1: / / #2: / / #3: / / Surface Antibody Titer (Circle One): *Titer 1-2 months after 3rd dose Positive or Negative *Healthcare provider intital each dose Date: / / (titer required with 3 doses) MMR (Measles, Mumps, Rubella) #1 / / Pos. Measles Titer: / / *2 doses of MMR vaccine *Dose-1 must be after 1st birthday #2 / / Pos. Mumps Titer: / / *Minimum 4 wks between doses Pos. Rubella Titer: / / (No titer required if two doses were given) VARICELLA (CHICKEN POX) #1 / / Disease History: / / *2 doses of Varicella vaccine *Minimum 4 wks between doses #2 / / AND **Titer required with history of Pos. Varicella Titer: / / disease. (No titer required if two doses were given) PPD TUBERCULIN SKIN TEST - REQUIRED ANNUALLY *Please note, depending on your site placement, a chest x-ray and/or annual TB symptom check may also be required if you have a history of a positive PPD. Site may require more than one PPD within a year. Date given: Date read: Results (mm): Circle Result: Positive Negative HEALTH CARE PROVIDER'S SIGNATURE (Required): I certifiy that this student has received the immunizations or has laboratory evidence of immunity as indicated on this page. Signature and Credentials Printed Name Date Office phone number Office Fax Number
Name: Date of Birth: Program / Graduation Year: Date: COLLEGE OF NURSING & HEALTH SCIENCES INFLUENZA VACCINE PRE-CLINICAL REQUIREMENT Influenza Vaccination Date Administered Manufacturer Lot Number Expiration Date Licensed Heath Care Provider Attestation By signing below, I affirm that I am a licensed health care provider. I am aware that leaving any required fields blank will result in the student being unable to progress in his/her major at the University of Vermont. Signature of Licensed Health Care Provider Credentials Date Clinic Stamp or Printed Name of Provider Provider Telephone Number It is MANDATORY that you scan and upload this form to CastleBranch UVM Student Health will not submit your paperwork for you. You will need to pick up your documents and submit them to CastleBranch. The information included on this form maybe released to the infection control officer and clinical education coordinators at sites where you perform your clinical education experience.
Frequently Asked Questions General Questions Q: What are CNHS Mandatories? A: CNHS Mandatories are college requirements that include proof of immunizations, health insurance, HIPAA/OSHA training, program memberships, etc. that all students need to fulfill to take part in clinical education. Depending on the requirements of your clinical placement site, there may be additional requirements to fulfill such as a physical exam, drug screen, background check or additional PPD test. Q: How do I submit my documentation? A: The College of Nursing and Health Sciences uses an online immunization tracker called CastleBranch for health clearance and mandatory requirements for all programs. Once you register and set up your account you will use the same account for the length of time you are in the College of Nursing and Health Sciences. Instructions regarding the use of CastleBranch for submitting your program mandatories will be emailed to you. Please note, UVM s Center for Health and Wellbeing will not submit your documents for you. You will need to receive your documents from them and submit them to CastleBranch. Q: What happens if I can t submit my mandatories by the deadline? A: It is imperative that you plan ahead to ensure that your mandatories are completed by the deadline. If you fail to submit your mandatories by the deadline, you will not be able to participate in your clinical experience and your instructor will be notified. It is important to give yourself plenty of time to complete these requirements and to pay attention to email reminders and take action on requests. Q: What is a titer? A: A titer is a blood test to determine whether a vaccination has provided immunity against the disease. Titer results should be positive to indicate immunity. CPR Certification Q: What CPR certifications will you accept? A: American Heart Association Basic Life Support for Health Care Providers OR American Red Cross Professional Rescuer Q: What if my CPR certification will expire during my clinical education experience? A: It is your responsibility to be aware of your CPR certification expiration date. Your CPR certification is required to be valid for your entire clinical education experience. If your CPR certification will expire during your clinical, please renew it BEFORE expiration and submit an updated copy of the front and back of your CPR card with signature(s) to CastleBranch.
Q: Will you accept the American Red Cross Challenge Exam for my CPR Certification course? A: No, this is a refresher course not a certification course. Q: How do I find out about upcoming CPR classes? A: CNHS offers CPR courses at least twice per semester. You will receive email notices regarding how to sign up through http://vtsafetynet.com/for upcoming CPR course dates. Q: How do I register for a CPR class? A: To register for a course through the American Heart Association, go to http://vtsafetynet.com/ Click on the Take a Course tab at the top. Click on the BLS for the HealthCare Provider course and fill out the registration. Payment will be due in cash at the class. (It will say FREE on the website but that is only for registration purposes.) The course we offer is $40 and is offered at a substantially discounted cost for UVM students. Hepatitis B Hepatitis B Receive 1 st dose, Receive 2 nd dose one month later, Receive 3 rd dose four months from 1 st dose; Receive titer 1 to 2 months after 3 rd dose. Q: What if my Hepatitis B titer is negative? A: If you received a negative Hepatitis B titer, ask your health care provider to revaccinate you with the three dose series as noted above. After the series, you will need another titer. You must receive all three doses. If you only receive two doses and a titer you will be asked to return to your health care provider to get the third dose and another titer. It is required that you submit each dose after it is given on the same updated Pre Clinical Mandatories form in the Repeat Hepatitis B section and the titer when it is complete. If you are participating in your clinical experience with a negative titer, please ensure that you have talked with your health care provider about universal precautions to prevent Hepatitis B infection. Q: How long after my three doses of Hepatitis B vaccinations can I have a titer drawn? A: The titer should be done one to two months after your third dose of the Hepatitis B vaccine. Q: Can I see two health care providers to complete my Hepatitis B series? A: Yes. If you plan to see two health care providers to complete your Hepatitis B series, please ensure that you provide your second health care provider with a completed form showing your most recent doses. Use one CNHS Hepatitis B Second Series form when seeing multiple healthcare providers. Q: What if my Hepatitis B titers keep showing as negative? A: If you have completed (2) three dose series of the Hepatitis B vaccinations and your titers are still negative, you are considered to be a non responder. Talk with your health care provider about precautions to prevent Hepatitis B infection. Please have your health care provider complete the Hepatitis B section of the Pre Clinical Mandatories form.
Varicella Q: How do I know if I need a titer? If you have had two doses of the Varicella vaccine you do not need a titer. If you have a history of the disease and have not had two doses of the vaccine, you will need a positive titer to show immunity. Q: My Varicella titer is indeterminate or negative. What should I do? A: If your Varicella titer is indeterminate or negative, you are required to have two Varicella vaccinations. After receiving the vaccinations, no further action is needed. HIPAA/OSHA Training Q: How often do I need to complete HIPAA/OSHA training? A: You are required to take annual on line training through Evolve e learning for HIPAA/OSHA training. OSHA training includes a Bloodborne Pathogens course. Information regarding these trainings will be emailed to you. Q: What happens if I can t access my coursework once I sign in to Evolve? A: In order to see your courses you should make sure you allow Pop Up Windows. You can do this by going to your toolbar under Tools, Options, and Privacy and Security and making sure that the Block pop up windows is not checked off. Influenza Vaccination Q: Am I required to get a flu shot? A: Yes, as a CNHS student you are required to receive an annual influenza vaccination both to protect yourself, and also to protect the patients with whom you come into contact. PPD Q: If I have a PPD Skin Test and it is positive, what should I do? A: First time positive only: You will need to be assessed to determine why the skin test is positive. Reasons may include previous BCG vaccine, latent TB (exposed, but not active), or active TB. This will require a symptom review done by your healthcare provider and chest x ray. You will need to submit a copy of the radiology report, the Symptom Checklist form, and the PPD form signed by your healthcare provider to CastleBranch. Q: If I have a history of a positive PPD, what should I do? A: Do not get another PPD skin test because this will continue to result as a positive. Instead, ask your health care provider to perform a TB symptom review. Bring your TB Symptom Checklist form to your appointment for the healthcare provider to fill out and sign. You will need to submit your Checklist in CastleBranch.
Q: What if I have difficulty getting an appointment with my doctor for my PPD? A: You often do not need a full office visit appointment for the placement and reading of your PPD. Ask if a nurse can place/read your PPD instead. Walk in clinics and pharmacies will also provide these services. Additional Questions Q: How will I know when my mandatories have been completed? A: Is it your responsibility to keep track of the documents that you submit to ensure you have met all requirements. You will know your mandatories are complete when all document trackers on your CastleBranch account display a green check mark. Take action to complete any requirement they reject. It is your responsibility to coordinate and maintain compliance and record keeping. The program will facilitate coordination to clinical sites, but this does not eliminate the need for you to maintain quickly available, complete and updated requirements at any time. Proof of Health Insurance, the Health Insurance form, PPD test, and the Influenza vaccine are all annual requirements. Q: Does CNHS cover the cost of my immunization and serology work? A: No, it is your responsibility to cover the cost. If you visit the UVM s Center for Health and Wellbeing for your immunization and serology work, you can request a receipt and file it along with the claim to your insurance company. Q: Who do I contact if I have additional questions? A: Christina Adamczak College of Nursing and Health Sciences 106 Carrigan Drive, 216 Rowell Bldg. Burlington, VT 05405 Christina.Adamczak@med.uvm.edu (802) 656 2018